This proposal demonstrates the great potential of the University of Virginia (UVA) to make major contributions to the NHLBI/NINDS sponsored Network for Cardiothoracic Surgical Investigations in Cardiovascular Medicine. Together with our consortium institutions, Inova Fairfax Hospital and Carilion Roanoke Memorial Hospital, our team performs an average of 3,000 adult cardiovascular surgical procedures annually (>800 cases at UVA alone) which would be available for recruitment in Network protocols. The investigative group is led by Dr. Irving L. Kron, a cardiothoracic and vascular surgeon who is Chair of the Department of Surgery at UVA. He has been involved in multiple national leadership roles that relate to cardiothoracic research and education. He also has received long term research funding from NHLBI. The co-principal investigator is Dr. Karen C. Johnston, a nationally recognized vascular certified neurologist with NINDS funding and expertise in clinical trials, neuroprotection and outcomes research. Additionally, Dr. John Dent, a nationally known cardiologist, provides specific expertise in echocardiography as it applies to valvular heart disease. The unique mix of cardiovascular surgery, stroke neurology/neurological outcomes, and cardiology in addition to a large urban and rural population base guarantees that UVA will make substantive and novel contributions to the Network for Cardiothoracic Surgical Investigations in Cardiovascular Medicine. Our specific aims include: Specific Aim 1: To describe the experience, expertise and collaborative nature of UVA that will substantially contribute to the success of a Network for Cardiothoracic Surgical Investigations in Cardiovascular Medicine. Specific Aim 2: To demonstrate the proof of concept for a subvalvular approach for ischemic mitral valve regurgitation by repositioning the posterior papillary muscle of the mitral valve in a phase II randomized clinical trial. Specific Aim 3: To demonstrate the efficacy and safety of perioperative Atorvastatin therapy for patients undergoing major cardiac surgery in a randomized, blinded, controlled phase III trial. Preliminary data have suggested that this intervention will reduce mortality and morbidity in cardiac surgical patients even without atherosclerosis. (End of Abstract)